Brain abscess (BA) is defined as a focal infection within the brain parenchyma, which starts as a localized area of cerebritis, which is subsequently converted into a collection of pus within a well-vascularized capsule. BA must be differentiated from parameningeal infections, including epidural abscess and subdural empyema. The BA is a challenge for the neurosurgeon because it is needed good clinical, pharmacological, and surgical skills for providing good clinical outcomes and prognosis to BA patients. Considered an infrequent brain infection, BA could be a devastator entity that easily left the patient into dead. The aim of this work is to review the current concepts regarding epidemiology, pathophysiology, etiology, clinical presentation, diagnosis, and management of BA.

https://www.thieme-connect.com/products/ejournals/pdf/10.4103/0976-3147.116472.pdf

Brain abscess: Current management

The efficacies of two different surgical approaches, aspiration and excision, were investigated for the management of large solitary encapsulated pyogenic brain abscess located in superficial non-eloquent areas, and the impact on length of hospital stay, duration of postoperative antibiotic use, improvement in neurological status, and morbidity and mortality were compared. This retrospective study at Sher-i-Kashmir Institute of Medical Sciences included 47 patients with pyogenic brain abscess from a total of 114 patients evaluated in the Department of Neurosurgery over a period of 10 years from October 2001 to October 2011. Comparisons were made between aspiration and excision in terms of duration of antibiotic use, length of hospital stay, and overall treatment cost. Aspiration was performed in 29 patients (61.7%), of whom 7 patients needed second aspiration, and 18 patients underwent excision (38.3%) of the abscess capsule. The mean duration of antibiotic use in the excision group was significantly shorter at 2.7 weeks (standard deviation [SD]±1.1) compared to the aspiration group at 3.8 weeks (SD±1.3) (p=0.006). Similarly, mean length of hospital stay was significantly shorter in the excision group at 18.1 days (SD±7.7) compared to the aspiration group at 24.9 days (SD±6.6) (p=0.002). In addition, significantly earlier improvement in neurological function (p=0.025) and significantly lower rate of re-surgery (p=0.0238) were found in the excision group compared to the aspiration group. Excision is better than aspiration as far as duration of antibiotic use, length of hospital stay, and overall cost of treatment is concerned, with no significant difference in morbidity and mortality.

Aspiration versus excision: a single center experience of forty-seven patients with brain abscess over 10 years.

Objective. To investigate surgical (aspiration and resection) outcome of encapsulated brain abscess in superficial non-eloquent area. Methods. We searched Pubmed, Embase and Cochrane Library from the foundation of the database till December 2013. Two researchers screened literatures independently, assessed the quality of the included studies and extracted the data. Revman 5.2.8 was used to do meta-analysis. Results. A total of five studies were included, all retrospective cohort studies. Eighty-four cases were in the abscess aspiration group and 124 cases were in the abscess resection group. Meta-analysis showed that the abscess resection group had lower rate of postoperative residual abscess, lower re-operation rate, higher rate of improvement in neurological status within 1 month after surgery, their OR (95% Confidence Interval (CI)) were 0.12 (0.04, 0.34), 0.07 (0.02, 0.20), 7.9 (3.20, 19.51) respectively; the abscess resection group had shorter duration of post-operative antibiotics and averag...

Surgical outcome of encapsulated brain abscess in superficial non-eloquent area: A systematic review.

Objective To determine the efficacy of burr hole aspiration of brain abscess in children with cyanotic heart disease in terms of number of aspirations and residual abscess. Study design Experimental study. Place and duration of study Department of Pediatric Neurosurgery at The Children's Hospital and The Institute of Child Health, Multan, from July 2010 to June 2014. Methodology Pediatric patients of cyanotic heart disease with brain abscess were admitted. After taking history, clinical examination and necessary investigation, aspiration of abscess through a burr hole was performed. Data was collected through pre-designed proforma. Analysis of results was performed and comparison was made through statistical package for social sciences (SPSS-20). Results Total number of patients were 50 with 31 (62%) male and 19 (38%) female children. Patients' age ranged from 5-10 years with mean age of 7.44 ±1.11 years. Single abscess in supra tentorial was commonly found in 44 (88%) patients. Multiple abscesses were present in 4 (8%) patients. Cerebellum was involved in 2 (4%) patients. Abscess was completely aspirated in single attempt in 37 (74%) patients, two attempts in 9 (18%) patients, and three attempts in 4 (8%) patients. No bacterial growth on culture was reported in 32 (64%) patients. Culture was positive in 18 (36%) patients. Postoperative hematoma developed in 2 (4%) patients. No mortality was reported in early postoperative period. Conclusion Aspiration of brain abscess in children with cyanotic heart disease through a burr hole is safe and successful.

Burr Hole Aspiration of Brain Abscess in Children with Cyanotic Heart Disease.

Purpose of review Complications of otitis media are a cause of significant morbidity and mortality, compounded in resource-constrained settings in which human and physical resources to manage disease are suboptimal. Here, we examine the current best evidence to devise a protocol for management, in particular exploring the opportunity for conservative or nonspecialist management. Recent findings Reviews of the literature suggest that intratemporal and extracranial infections can be managed with antibiotics in the first instance, with aspiration or incision and drainage of abscess. Failure to respond necessitates mastoidectomy, which need not be extensive, and can be performed with hammer and gouge. Suspected or possible intracranial extension requires referral for computed tomography (CT) imaging. Intracranial infection can in some instances be managed with antibiotics, but large or persistent intracranial abscess, or the presence of cholesteatoma requires management in a centre for specialist surgery. Summary Many complications of otitis media could be managed by nonspecialists in appropriately equipped local or regional health facilities, and supported by appropriate training. However, regional centres with CT imaging and specialist surgery are required for assessment and treatment of cases that are suspected of having complex or advanced disease, or that fail to respond to initial treatment. Those involved in planning healthcare provision should look to develop infrastructure to support such management.

Management of infective complications of otitis media in resource-constrained settings.

Background: The purpose of the study is to compare the two surgical
methods (burr hole and craniotomy) used as treatment for superficial
cerebral abscess and its outcome in terms of radiological clearance on
brain CT, improvement of neurological status, the need for repeated
surgery, and survival and morbidity at three months after surgery. This
report is a retrospective case review of the patients who were treated
surgically for superficial cerebral abscess in Hospital Kuala Lumpur
(HKL) and Hospital Sultanah Aminah (HSA) over a period of four years
(2004 to 2007). Methods: Fifty-one cases were included in this study:
64.7% of patients were male and 35.5% were female. Most of the patients
were Malay (70.6%); 28 patients (54.9%) had undergone craniotomy and
excision of abscess, and the rest had undergone burr hole aspiration as
their first surgical treatment. Results: This study reveals that
patients who had undergone craniotomy and excision of abscess showed a
significantly earlier improvement in neurological function, better
radiological clearance and lower rate of re-surgery as compared to the
burr hole aspiration group (P-value < 0.05). However, with respect
to neurological improvement at 3 months, morbidity and mortality, there
is no significant difference between the two surgical methods.
Conclusion: The significance of these findings can only be confirmed by
a prospective randomised series. Further study will be required to
assess the cost effectiveness, intensive care needs, and possibility of
shorter antibiotic usage as compared to burr hole aspiration.

/pdf/treatment-outcome-of-superficial-cerebral-abscess-an-b738wjajz5.pdf

Wei Ming Tan

Papers

Treatment outcome of superficial cerebral abscess: an analysis of two surgical methods.